Understanding the Context of Health for Persons With Multiple Chronic Conditions: Moving From What Is the Matter to What Matters

被引：136

作者：

Bayliss, Elizabeth A. ^{[1
]}

Bonds, Denise E. ^{[2
]}

Boyd, Cynthia M. ^{[3
,4
]}

Davis, Melinda M. ^{[5
]}

Finke, Bruce ^{[6
]}

Fox, Michael H. ^{[7
]}

Glasgow, Russell E. ^{[8
,9
]}

Goodman, Richard A. ^{[7
,10
]}

Heurtin-Roberts, Suzanne ^{[8
]}

Lachenmayr, Sue ^{[11
]}

Lind, Cristin ^{[12
]}

Madigan, Elizabeth A.

Meyers, David S. ^{[13
]}

Mintz, Suzanne

Nilsen, Wendy J. ^{[14
]}

Okun, Sally ^{[15
]}

Ruiz, Sarah ^{[11
,16
]}

Salive, Marcel E. ^{[17
]}

Stange, Kurt C.

机构：

[1] Kaiser Permanente, Denver, CO USA

[2] NHLBI, Bethesda, MD 20892 USA

[3] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[4] Bloomberg Sch Publ Hlth, Baltimore, MD USA

[5] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[6] Indian Hlth Serv, Nashville, TN USA

[7] Ctr Dis Control & Prevent, Atlanta, GA USA

[8] NCI, NIH, Bethesda, MD 20892 USA

[9] Univ Colorado, Sch Med, Denver, CO USA

[10] Dept Hlth & Human Serv, Off Assistant Secretary Hlth, Atlanta, GA USA

[11] Natl Council Aging, Washington, DC USA

[12] Karolinska Inst, Stockholm, Sweden

[13] Agcy Healthcare Res & Qual, Rockville, MD USA

[14] NIH, Off Behav & Social Sci Res, Bethesda, MD 20892 USA

[15] PatientsLikeMe, Cambridge, MA USA

[16] Univ Chicago, Chicago, IL 60637 USA

[17] NIA, Bethesda, MD USA

来源：

ANNALS OF FAMILY MEDICINE | 2014年 / 12卷 / 03期

关键词：

multiple chronic conditions; chronic illness; health services research; QUALITY-OF-LIFE; RANDOMIZED CONTROLLED-TRIALS; TEAM SCIENCE; PRIMARY-CARE; EXTERNAL VALIDITY; BIOPSYCHOSOCIAL MODEL; COMPLEXITY SCIENCE; PATIENT-CARE; NEED; MULTIMORBIDITY;

D O I：

10.1370/afm.1643

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

100235 [预防医学];

摘要：

PURPOSE An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

引用

页码：260 / 269

页数：10

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